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Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress Disorder

[See editorial comments by Dr. Soo Borson, pp 1797-1798]

Authors

  • Salah U. Qureshi MD,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Timothy Kimbrell MD,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Jeffrey M. Pyne MD,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Kathy M. Magruder MPH, PhD,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Teresa J. Hudson Pharm D,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Nancy J. Petersen PhD,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Hong-Jen Yu MS,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Paul E. Schulz MD,

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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  • Mark E. Kunik MD, MPH

    1. From the *Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service and Neurology Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Neurosensory Center, §Department of Neurology, ‡‡Department of Medicine, and §§Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center; #Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; **Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and ††Ralph H. Johnson Veterans Affairs Medical Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
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Address correspondence to Mark E. Kunik, Houston Center for Quality of Care & Utilization Studies, Michael E DeBakey VAMC (152), 2002 Holcombe, Houston, TX 77030. E-mail: mkunik@bcm.tmc.edu

OBJECTIVES:

To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans.

DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network.

SETTING: Veterans Integrated Service Network 16.

PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH−, n=3,660), those with PH and no PTSD (PTSD−/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD−/PH−, n=5,165).

MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression.

RESULTS: The PTSD+/PH− group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH− group as in the PTSD−/PH+ or PTSD−/PH− group after adjusting for the confounding factors. There were no statistically significant differences between the other groups.

CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care.

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